Inside a CPAD Assessment: When an Insurer Tests Your Ability to Work with ME
If you’ve been diagnosed with ME (myalgic encephalomyelitis), you may already know that a lack of treatment and dead ends for support are common. Where insurance is concerned - a benefit from my employer in this case. A Chronic Pain Ability Determination (CPAD) assessment is designed to test whether you’re fit to work, usually at the request of an insurer that wants to verify, stop, or reduce a payout.
I’ve written before about my ME diagnosis but going into these sessions I’ve had about a month of spontaneous remission from severe levels to what I’d now call mild or near-recovered, aside from ongoing autonomic dysfunction and some sleep issues.
I have been able to cycle for an hour, walk 2 miles etc without any Post-Exertional Malaise (PEM) at all. This post isn’t about that history though. It’s about what actually happens inside a CPAD assessment, step by step, so other ME patients facing one know roughly what to expect.
Although my remission and ability to do the assessment should be noted as it may have been different had I been as severe as I was about 3 months ago. I approached the session with a few nerves of not knowing what to expect but also with an idea to test myself that my intention to return to work as soon as possible was viable.
Who conducted it
An occupational health assessor with a background focused on chronic pain, brain conditions, and MS. They were aware of ME as a condition going in and fibromyalgia, which is not something every claimant can count on. They were very friendly and relaxed and encouraged me to ask for breaks if I needed them several times.
Setting and length
In person, in a hotel meeting room, located fairly close to home. The session ran from 9am to 12:15pm, just over three hours, and I was aware it could have run longer to about four hours as it’s dependent on the pace to complete tasks and more if rest breaks were needed. I took two 5 minute breaks between sessions 1 and 2 and another between 3 and 4.
Structure of the assessment
The session had four parts, in this order:
- History interview, verifying details provided by insurance company and a can I do or not do quick fire test
- Blood pressure and heart rate checks.
- Physical motor skills testing.
- Computerised cognitive testing.
1. History interview
The assessor took notes throughout. Given my current recovery state , we didn’t spend much time on the severe period of my illness. The focus was mostly on the last month and what the I framed as “readiness for work” as I had already spoken to my employer about a phased return to work.
They did ask about PEM (post-exertional malaise) specifically, but again, this wasn’t explored in depth given how the interview was framed. I covered how things I was able to do now that I couldn’t do before during my history as passing dialogue.
They then asked a series of quick fire questions on am I able or unable to do a thing. e.g. shower, cook, clean etc. This is where more people suffering would like answer yes, but they should say no, because symptoms happen.
2. Blood pressure, heart rate and pain
This was a seated check, not a full orthostatic test (no lying-to-standing or NASA lean test protocol) for POTs etc. Readings were taken three times: an initial reading, a second about five minutes later as per standard practice, and a third later in the session because the readings were running high.
The high reading wasn’t discussed or connected to my autonomic dysfunction or ME history. It was logged as a number. I was asked to consent to continue and told to see a GP as a precaution which was fine.
I was asked before and again at the end how I would rate my pain on a scale as I felt, this was around 2 or 3 out of 10. I have some nerve pain and leg pain particularly around the knees.
3. Physical motor skills testing
This covered two types of tests.
Grip and pinch strength, using a dynamometer-style tool:
- Thumb and forefinger pinch grip
- Full hand grip, sustained for 3 seconds at maximum effort
- Full hand grip at different hand positions (like rungs on a ladder)
- Each test repeated 3 times per hand, left and right
Pegboard-style dexterity test:
- Moving two rows of pins into two rows of holes
- Left hand x3, right hand x3, both hands x3
- Repeated again with larger pins, more like bolts
I stayed fairly consistent across the three repetitions on each test, and the on-screen display looked consistent too. I wasn’t shown the recorded results or told how they compared to a normal range.
Worth noting: I’d expect a real drop-off across repetitions for many ME patients, particularly. A single session that shows consistency doesn’t rule out PEM or ME. It may just mean the crash hasn’t hit yet.
4. Cognitive testing (laptop-based)
This took roughly 30-45 minutes and covered a fairly standard neuropsychological battery:
- Digit-symbol substitution: matching coded images to numbers across a symbol array
- Stroop test: identifying when a coloured word matches its meaning (e.g. the word “blue” printed in green would be a flag), and the inverse version
- Memory recall: previously shown words and geometric shapes, tested for delayed recall
- Response rate to tapping keyboard when the letter B appeared
- Tapping left and right shift when a object matched colour or shape as noted on each object. This became quite fast at the end, and I felt out of sync and probably performed badly at the end.
I felt okay throughout but noticed some fatigue toward the end, including a glare or “ghosting” effect when letters disappeared from the screen during the Stroop sections. This might be my eyesight, or a laptop issue.
The instructions before testing
Before the physical and cognitive tests, I was told I could say if a test would make me worse or was beyond my ability. I was also told to try my best, since the assessment can monitor for what was described akin to faking a lower effort.
The follow-up session
A second session is scheduled two days after the first, to report back on how I feel. This appears to be built in specifically to capture delayed PEM, which is a notable departure from a single-snapshot assessment model. I haven’t had this session yet and will cover it separately once it happens.
What stood out
A few things worth flagging for anyone else going through this:
- The assessor had relevant background knowledge, which isn’t guaranteed.
- The high blood pressure reading was logged but not connected to the autonomic dysfunction that’s part of my ME picture.
- The strength and dexterity testing showed consistency across reps, but a single three-hour window won’t capture delayed-onset PEM, which is the actual defining feature of ME’s exertion response.
- The built-in follow-up session is a rare and reasonable acknowledgment that a one-day snapshot isn’t the full picture for a fluctuating, delayed-response condition.
I’ll update this post after the follow-up session.
Frequently Asked Questions
What is a CPAD assessment
- A Chronic Pain Ability Determination assessment. It’s used, typically at an insurer’s request, to assess whether someone claiming disability benefits is able to work.
Who carries out a CPAD assessment
- In my case, an occupational health assessor with experience in chronic pain, brain-related conditions, and MS. The specific background of the assessor can vary. They were self-employed and working on behalf of a separate health company to the insurance provider.
How long does a CPAD assessment take
- My session ran just over three hours (9am to 12:15pm), and I was told it could run longer depending on my pace and whether I needed breaks, typically 4 hours.
What does a CPAD assessment involve
- In my case: a history interview, blood pressure and heart rate checks, physical motor skills testing (grip strength and pegboard dexterity tests) and some range of motion and repetition designed to reflect my sedentary role in a work context, and computerised cognitive testing (processing speed, Stroop test, memory recall).
Does a CPAD assessment test for PEM (post-exertional malaise)
- PEM was asked about during the history interview, but not explored in depth in my case due to my focus on recovery. A follow-up session two days later was scheduled specifically to capture how I felt afterward, which does allow for delayed PEM to be reported, even if the main testing day doesn’t directly measure it.
Does the assessment test for orthostatic intolerance or autonomic dysfunction
- Not directly. Blood pressure was checked three times, but this was a seated check, not a lying-to-standing or lean test protocol that would specifically test for orthostatic changes for common co-morbidities like POTs
What happens if a test makes your symptoms worse
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I was told I could decline or flag if a test risked worsening my symptoms or was beyond my ability. I felt comfortable to do so with this accessor, but didn’t need to. All tests felt well within my capability today.
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I was also told to try my best, as the assessment includes monitoring for effort and consistency. I’m not sure how it could tell.
Do you get your results on the day
- No. Results from the strength and dexterity tests weren’t shared with me during the session, and I wasn’t given a running interpretation of the findings.
Is there a follow-up session
- Yes. A second session is scheduled two days after the first, to report on how I’ve felt since. This appears designed to capture delayed-onset PEM, which the single testing day doesn’t directly assess. The second session is likely to be two hours and include more physical and cognitive tests.
